← Back to list
Updated Prior Authorization Expansion on Physician-Administered Drugs
Effective date
Nov 15, 2025
Identified
Jun 18, 2026
Summary
South Carolina Medicaid is expanding prior authorization requirements for additional physician-administered drugs for fee-for-service Medicaid members effective November 15, 2025. Prior authorization requests must be submitted to Prime Therapeutics Management through their online portal or phone system.
Get alerts when payers change rules like this one
We check SC Medicaid - SCDHHS and other payers every day and email you when a change matches your specialty and state.
Get SC Medicaid - SCDHHS alertsPolicy Monitoring is free. No card required.
What to do
Action · 4 steps
01Before November 15, 2025: Billing team must review the updated list of physician-administered drugs requiring prior authorization in the SCDHHS Physicians Services Provider Manual.
02Update billing system to flag these medications for prior auth verification before administration to South Carolina fee-for-service Medicaid patients.
03Train staff to submit PA requests through gatewaypa.com or call 1-800-424-8219.
04Claims will be denied without proper prior authorization.
Original notice
Updated Prior Authorization Expansion on Physician-Administered Drugs
scdhhs.gov · Always check the source before changing claims.
Related changes
See all SC Medicaid - SCDHHS changes →Updated Prior Authorization Expansion on Physician-administered DrugsMediumEffective Dec 15, 2026 · Prior AuthorizationUpdated Prior Authorization Expansion on Physician-administered DrugsHighEffective Oct 1, 2026 · Prior AuthorizationUpdated Prior Authorization Expansion on Physician-administered DrugsHighEffective Jul 1, 2026 · Prior AuthorizationUpdated Prior Authorization Expansion on Physician-administered DrugsMediumEffective Aug 1, 2025 · Prior AuthorizationBrowse every SC Medicaid - SCDHHS change in the policy list